Physicians play an important, multi-faceted role in the overall healthcare chain. Their primary role involves examining the patient’s history and physical to determine the right diagnosis for a given disease or condition. Once the diagnosis is established, the physician develops appropriate management and treatment plan.
Besides treatment, physicians also provide continuous care to patients in ambulatory settings, advocates on behalf of patients and educates them, their families and support groups. The two main types of doctors are primary care physicians and specialists, who are trained to offer specialized services when called upon because of their training and knowledge. The emergence of Medicaid and Medicare has brought with it the universal right to access health care.
Medicare Participation Kit
A guidebook published by the American Medical Association (AMA) called Medicare Participation Kit is designed to help physicians make informed decisions about their role in the Medicare program. According to AAFP.org, physicians have 3 contractual options of joining Medicare. The first option is signing a participating agreement or PAR and accepting prevailing Medicare payments.
Secondly, they can choose to become non-PAR physicians. In this case, physicians decide how to bill patients beyond the limits set by Medicare patients based on a case by case analysis. The charges may include documented unassigned claims. Lastly, physicians may opt to become becoming private contractors. Under this arrangement, the physicians must agree to bill patients directly without accessing any Medicare payments.
Non PAR to PAR?
Physicians are allowed to change their contractual status from Non PAR to PAR and the other way round only once a year, during the appointed time. However, certain exceptions do apply; for example, when a physician changes his or her group practice or geographical place of practice. Physicians who want to change their status can do so at their own volition if they are not bound by any contractual agreement with the hospital, they serve health plan or any such entities tying them to PAR status. PAR physicians must accept Medicare approved amounts, which stands at 20% patient co-pay and 80% Medicare payments to cover full or partial services over the stipulated time frame. Physicians who want to enroll as private contractors must offer a 30 day’s notice before the first day of the quarter effected on the contract.
PAR Physicians who participate in the Medicare program are offered a number of incentives, including:
• Access to quicker, toll-free claims processing lines
• Receive 5% higher pay rate compared to Non PAR physician
• Connection with senior citizens and other people who require their services
The names of doctors who accept Medicare payments are easily accessible at Medicare and Medicaid service centers. According to HHS.org, patients can visit Medicare.gov website and check under the Physician Compare tab, then type the location of the physician and search by name, group practice, condition, specialty and other related parameters. The website also offers such details as interactive details such as physician’s profiles, maps and driving directions. The number to call in case you have a problem accessing the website is 1-800-MEDICARE. When you all the official Medicare help line a representative will guide you through the search process and answer all your queries. You can also use this opportunity to request a print out copy of the search results.
The other sources of information regarding physicians who participate in the Medicare program include the highly resourceful Medline Plus directories and via referrals from friends and relatives. Once you received a shortlist of Medicare doctors in your private health plan network (PFFS, HMO and PPO), it is important to pick one practitioner you are comfortable working with. According to Consumerreports.org, your search considerations should revolve around the physician’s hospital affiliation, underlying red flags, compatibility, board certification and gender and age if that is important to you. You may go further to find out if the doctor makes house calls; can reached easily through an appointment and also seek information about the working hours and locations.